Get Genetic Counseling Intake Form-1 - Diablo Valley

Completing the Genetic Counseling Intake Form-1 - Diablo Valley is an important step in your genetic counseling process. This guide will provide you with clear and supportive instructions to help you fill out the form online efficiently.

Follow the steps to complete the form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the patient information section. Enter your first and last name, date of birth in MM/DD/YY format, occupation, address, city, state, zip code, and county if you are in California.
3. If applicable, provide partner information in the designated section. Input their first and last name, date of birth, and occupation.
4. In the pregnancy information section, indicate if you are currently pregnant by selecting 'Yes' or 'No'. If you select 'Yes,' enter your due date.
5. List any regular medications you are taking in the provided field. If pregnant, also note any other medications taken during pregnancy aside from prenatal vitamins or Tylenol.
6. Answer the questions regarding substance use and conditions by marking 'Yes' or 'No' for each item listed.
7. Fill out your contact information including home, cell, and work phone numbers. Identify who else can receive results on your behalf and include their phone number.
8. Provide consent for leaving confidential messages by signing the release statement and noting the confidential phone number.
9. Confirm that you have answered all questions to the best of your knowledge by signing and dating the form.
10. Once you have completed the form, ensure to save your changes, then download, print, or share the completed document as needed.

Begin filling out the Genetic Counseling Intake Form-1 online now to take the first step towards your genetic counseling.